Bopha, 13, is the top student in her class in remote Boeung Kachang village, located in the islands and mangrove forests of Koh Kong province. When she grows up, she wants to be a doctor, because she has seen many women in labour pains travelling long distances by boat due to the lack of medical services in her village. She wants to give free medical care to all her villagers.
From the relative comfort of Phnom Penh, it is easy to forget about the plight of children living in remote areas of Cambodia. At the national level, Cambodia has made astonishing progress in health and education. The maternal mortality rate has decreased from 472 per 100,000 live births in 2005 to 170 in 2014. Under-five mortality decreased from 83 per 1,000 live births in 2005 to 35 in 2014. The pre-school net enrolment rate for 3 to 5-year-old children has increased from 18 to about 25 percent over the period 2005-2012, with about 35 percent of five year olds enrolled. The education budget has increased year on year, and reforms are changing the way that children learn.
But progress has been unequal, and these positive statistics mask great regional disparities. In remote areas, less than 60% of children finish primary school and the dropout rates amongst primary school children in remote areas are higher than the national average. Data from the Cambodia Demographic Health Survey show that coverage of health services in some provinces is less than half of the national average. A child in Kratie is four times more likely to die before the age of 5 than a child in Phnom Penh.
Access, delivery and quality of health care and education are issues of major concern for families living in remote areas of Cambodia. Coverage and quality of services is not equitable and healthcare and education are still inaccessible for many, particularly the rural poor. Provinces in the Northeast of Cambodia, Preah Vihear, Koh Kong and provinces bordering the Tonle Sap Lake face issues of isolation due to geographic factors such as lakes, rivers, tributaries, forests and mountains, combined with poor infrastructure. This limits families’ ability to seek transportation for services any time of day or night and adds an additional burden in terms of time and financial costs to seeking services. Women in the Northeast of Cambodia on average will spend nearly 70% of the time they allocate to seeking health services on travel.
Bopha may or may not be able to pursue her dream to become a doctor. Like so many other students of her village, her father is unsure if he will be able to afford to pay the extra costs for commuting to secondary school in Koh Kong city and the costs of supplementary educational materials. Bopha is aware of all this and she knows that there is a huge difference in the dreams of her future and the harsh reality of her present, but nevertheless she continues to study hard and excel at her school, in the hope that something will give, eventually, and one day she will become the first doctor in her village.
It is to reach children like Bopha – the most remote, the most vulnerable to shocks, and the poorest of the poor – that Save the Children is launching a new campaign, Every Last Child, to advocate for the extension of healthcare and education services to the most rural and remote areas.
Cambodia has changed very rapidly in the recent past and will continue to evolve along a growth route that will involve transiting to Middle Income Country status in the near future. However, social equity will not be reached unless there is a concerted effort to reach marginalized children in remote areas of Cambodia.
At Save the Children we know that, like Bopha, we must continue to be passionate, resilient and hopeful. The progress that has been made at a national level can be extended to all provinces of Cambodia. We must work together, whether we are civil society, government or community members. Together, we can reach every last child – but we must start now.